Combination Chemotherapy with 5-Fluorouracil, Vinblastino and Cisplatin (FVF) in thc Advanced Non-Small Cell Lung Cancer / 대한내과학회지

The 5 year survival rate after surgical resection for stage III non-small cell lung cancer(NSCLC) remains short, only 10-19%. Radiotherapy seems to show some benefit for local control, but it does not reflect to prolongation of survival, as distant metastasis prevails. Vinblastine is one of the most active agent against NSCLC. 5-Fluorouracil(5-FU) and cisplatin are synergistic in anti-cancer activity in adenocarcinoma of gastrointestinal tract and squamous cell cancer of head and neck. We initiated a phase II trial for advanced NSCLC to determine the effect of FVP regimen in response rate, survival and toxicities. The therapy consisted of 5-FU 500mg/m2/12 hours continious IV infusion for 36 hours from day 1, vinblastine 3mg/m2 IV bolus day 1 and 2, cisplatin 75mg/m2 IV infusion over 2 hours day 1 and it was repeated every 3 weeks. Among the 45 patients entered into this study, 40 patients were evaluable for response. The objective response rate was 50%(CR;1/40, 2.5% PRi19/40, 47.5%). The median survival of all the patients was 42.9 weeks(8.4+ - 140.6 weeks); the responding patients survived longer than the non-responders(mediansurvival; 54.4 weeks vs 29.7 weeks, p<0.05). The toxicities of this regimen were acceptable but 1 patient died of pneumonia associated with granulocytopenia. We concluded that the FVP regimen is effective in the treatment of advanced non-small cell lung cancer and a prospective randomized trial and long- term follow up is warranted.

A Case with Isolated ACTH Deficiency / 대한내분비학회지

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. Adrenal crisis in isolated ACTH deficiency is less common compared to primary adrenal insufficiency, but isolated ACTH deficiency is an important cause of hypoglycemia. Recently we experienced a 41-year-old man admitted because of mental confusion. On admission, plasma glucose and sodium concentration were 1.7, 132 mmol/L, respectively. Basal plasma ACTH and cortisol levels were low and other pituitary hormone showed normal response to combined pituitary stimulation test except growth hormone. Plasma ACTH concentration remained low even after intravenous injection of ovine corticotropin releasing factor. It suggest that the defect of ACTH secretion was apparently due to intrinsic pituitary rather than hypothalamic disease. The sellar CT showed the fossa to be filled by cerebrospinal fluid. After treatment with glucocorticoid, he had no further evidence of hypoglycemia and hyponatremia. In conclusion, we report a case of isolated ACTH deficiency with empty sella.